Tag: COVID-19

COVID-19: Dexamethasone provides some hope for severely ill

In a trial, Dexamethasone, an inexpensive and widely used corticosteroid, reduced deaths by one-third in ventilated patients and by one-fifth in patients receiving oxygen support

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By Prabir Purkayastha/peoplesdispatch.org

June 20, 2020: There is some welcome news. We now have a medicine that can reduce COVID-19 fatalities. While the medicine reduced fatalities in critically ill patients by about a third, its effect was less on those who were less ill. The best part is that the drug – dexamethasone – is an off-patent, widely used, and a cheap corticosteroid. It acts to reduce the inflammation of the lung and in other organs, a major cause of death among those seriously ill with Covid-19. The Oxford University’s RECOVERY trial has enlisted a large number of patients from the NHS Hospitals, and are trying out a number of drugs to see their efficacy. In this case, they had randomized 2,104 patients, who received dexamethasone, compared with other 4,321 patients in the normal care arm of the trial.

Among the patients in the normal care arm, 28-day mortality was 41% among those on ventilation, 25% in those patients who required oxygen support only, and the lowest – 13% – among those who did not require any respiratory support. Dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in patients receiving only oxygen support. There was no benefit among patients who did not require any respiratory support.

Corticosteroids are widely being used to contain the inflammation of an overactive immune system. The problem is that steroids, while containing the inflammation, also weaken the body’s natural immune response against the virus and other bacterial co-infections that are present in patients. Therefore, it had been argued that steroids could be harmful to COVID-19 patients. The challenge in using steroids is to keep the dosage high enough that we can dial down the body’s overactive immune response, and suitably low so that it does not reduce the immune response too far, allowing viruses and bacteria a free hand. Then we can effectively control the inflammation without harming the patient.

Cytokine storm is the name given to the body’s out-of-whack immune response that causes severe inflammation, which itself may then become the cause of death. The major cause of death during the 1918 Flu pandemic was cytokine storm. This is also a major cause of death in Covid-19 patients.

The immune system in the body has a number of responses to infections. A corticosteroid reduces the immune response of the body by reducing all these responses; or as Professor Satyajit Rath of IISER Pune described to Newsclick, acts like a sledgehammer. We have another drug that is showing some promise as well, Genentch’s tocilizumab, an immune system inhibitor that specifically blocks one major pathway – the interleukin pathway – but not the other. It has also shown promise in a much smaller randomized trial in France. This allows a more selective blocking and allows other parts of the immune system to attack infections. The problem with tocilizumab is that it is a monoclonal antibody and much more expensive to produce, even if we did not add the cost of the patent monopoly of Genentech, a unit of Roche. Its cost in India is Rs. 40,000 a dose, and a patient requires at least 2 doses. Compare this to dexamethasone that costs only a few rupees for a pack of 20 tablets.

While the more serious cases need to stop the body’s immune system from attacking the patient’s lung and other organs, are there medicines that attack the virus growth itself? It is now clear from various clinical trials that hydroxychloroquine is not effective against the disease and has serious side effects. Gilead’s remdesivir seems to have some positive effect, provided it is given early enough and for patients who are not seriously ill. In a randomized double-blind trial, Gilead has reported in a press release that there is a reduction of 4 days in hospital stay for COVID-19 patients. It is also clear that remdesivir and other anti-virals undergoing drug trials are effective if taken early but have little or no effect on seriously ill patients. Remdesivir, unlike certain other anti-virals, is also a small molecule drug, which means that it can be produced quite cheaply, provided patent fees are nominal. But here is the rub: will Gilead agree to lower its patent royalties? If not, will governments, and that includes the Indian government, do what Bangladesh has done – allow any company to break Gilead’s patent? Under Indian law and the WTO’s Doha Declaration of 2001, any country has the right to issue a compulsory license under a health emergency or an epidemic. No one in their right mind is going to disagree that COVID-19 represents both. The only question is if there is the political will to do so, making it available cheaply for every person infected.

It may be asked what benefit a reduction of four days gives us which makes breaking a patent worthwhile. The answer that Professor Rath gave is that even if it reduces the infection by 4 days, it will reduce the infectious period of the patient and therefore, lower virus transmission. Reducing virus transmission means reducing the spread of the epidemic, which is an important public health measure.

So there is some hope yet on the medicine front – dexamethasone for severely ill and remdesivir for not so ill patients. Both are small molecules and not biologics, whose production can be quickly scaled up. Dexamethasone is off patents and so has no encumbrances. For remdesivir, we have a fight on our hands to see that it is made widely available. We have yet to see what happens on the vaccine front. This is another battle, with Trump already indicating the vaccines are his new weapons to ‘Make America Great Again’. The key issue is to ensure that the fight over Covid-19 medicines should not become a repeat of the fight over AIDS medicines. For that, Big Pharma and their patron governments have to behave differently.

The article was first published in peoplesdispatch.org

SPEAKING UP: If you do not feel for humanity, you have forgotten to be human

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Antún Kojtom Lam (Mexico), Ch’ulel, 2013.

By Vijay Prasad

The coronavirus continues its contagious march across the planet: almost 350,000 known deaths and over 5.4 million people infected. Meanwhile, in the Bay of Bengal, Cyclone Amphan makes its fierce landing, its immense energy tearing a corridor through Bangladesh and India (Odisha and West Bengal). If you do not feel for humanity in this period, you have forgotten to be human.

At the Tricontinental: Institute for Social Research, we continue with our studies on CoronaShock, which illuminate why the capitalist order has spluttered before this pandemic, while the socialist sections have recovered much faster. In 2005, the former International Monetary Fund economist Kenneth Rogoff wrote, ‘The next great battle between socialism and capitalism will be waged over human health and life expectancy’. Our assessment is that one of the reasons for the advances in the socialist parts of the world, despite their economic poverty, is that they take science seriously. For that reason, in consultation with a range of scientists and engineers, we have produced Red Alert #7 to explain the virus and antidotes to it.

What is the difference between a virus and bacteria?

Virus and bacteria are two major kinds of microbes infecting humans. Bacteria are one of the oldest living organisms and have all of the necessary components to live and reproduce. Only a small number of bacteria cause human disease; many of them are good bacteria. Some are even necessary for our survival.

Viruses are not defined as fully living organisms, as they cannot reproduce by themselves. They are a small bit of genetic material contained in a protein envelope. They are also generally much smaller than bacteria.

Viruses are genetic parasites that need other living cells to reproduce themselves. When they invade the cells of their host, they hijack the cell’s biochemical machinery to make a very large number of copies of themselves. These copies are then released from the cell, sometimes killing it in the process, then infecting other cells and repeating the cycle.

Bacteria are easier to kill, as they have their own distinct chemical processes that drugs can attack, and they reproduce more slowly than viruses. We have a whole host of medicines, from the older sulfa drugs to other antibiotics, that successfully control bacterial infections in our bodies.

What is the novel coronavirus?

SARS-CoV-2 belongs to a family of viruses called coronaviruses that usually infect mammals and birds. There are seven coronaviruses that infect humans, four of which have crossed over earlier. SARS-CoV-2, the virus that causes the disease COVID-19, is one of the coronaviruses; it has spiked projections on its surface, which resemble a crown or corona when studied under a microscope.

The chances of viruses crossing over from other species to human beings increase if these species are in close contact with us. Therefore both, factory farming and live markets of animals and birds provide opportunities for such transfers, which are called zoonotic transfers.

Bats often serve as a major reservoir of these viruses. The crossover from bats to humans can happen directly, or it can happen through other animals acting as intermediate hosts. Cats, monkeys, pangolins, and dogs can also harbor such viruses, and therefore can act as intermediaries between bats and us. Several viruses – such as Ebola, rabies, encephalitis, SARS (now renamed as SARS-CoV-1), Chikungunya, Zika, and Nipah – have jumped from bats to humans in this way.

Apart from bat viruses, some of the other viruses that have caused epidemics in humans come from birds and pigs. The most well-known virus group that is shared by pigs, birds, and us, is made up of the different strains of flu viruses. It was swine flu or bird flu that was responsible for the 1918 Spanish flu, which probably started in Kansas. It also caused the 2009-2010 pandemic that started in North America, infecting approximately 1.6 million people and killing an estimated 284,000. The deadly H5N1 influenza, which is currently seen to be a major threat, is a combination of swine and avian flu. It spreads through birds and then to the human population through domesticated ducks, poultry, or poultry farms.

As viruses do not have the full mechanisms of a living cell, they use those of host cells. Viruses have either DNA or RNA. DNA carries our genetic code, while RNA uses this genetic code to produce the proteins that our body needs. RNA viruses include hepatitis C, Ebola, SARS (both variants), influenza, polio, measles, and HIV, which causes AIDS. The novel coronavirus – or SARS-CoV-2 – is an RNA virus.

Why has this novel coronavirus caused so many deaths?

SARS-CoV-1 and MERS-CoV-1 both had much higher mortality rates than SARS-CoV-2. In SARS, the infection to fatality rate (people dead out of the total infected) was 11 percent, while in MERS, it was approximately 35 percent. In comparison, SARS-CoV-2 or COVID-19 deaths are in the region of 1 percent – much less than SARS or MERS. However, this is significantly higher than the flu, which has an infection to a fatality rate of less than .1 percent.

SARS-CoV-2 is dangerous, as it is easily passed from one person to another. It is this ability to transmit easily from one infected person to another that leads to a very large number of infections, and therefore to a very high level of total deaths. SARS-CoV-2 affects people over 65 much more seriously. The higher the age group, the more likely they have other risk factors such as heart disease, diabetics, cancer, asthma, or other chronic diseases. It is this – among other risk groups, such as those that are immune-compromised or have existing respiratory conditions – that is seeing a much higher death rate in the COVID-19 pandemic. This has been compounded in countries with a large presence of nursing homes, where elderly patients with weak immune systems and many chronic diseases live close together, fuelling the spread of the infection. But this does not mean that COVID-19 is dangerous only for the elderly.

SAR-CoV-2 has more effectively adapted itself to its human hosts than SARS-CoV-1 and MERS have. When the current version of the COVID-19 virus mutated, either in us or in a yet unknown intermediate host, it became particularly effective in binding itself to human cells. The spike protein on the surface of SARS-CoV-2 binds to the ACE-2 receptors that lie on the surface of a large number of our cells, from the lungs to our liver, kidneys, and intestinal tract.

The initial infection is most likely to occur through airborne particles carried in droplets released by those infected. Therefore, the initial infection takes place in the nose, throat, or upper respiratory tract. If the body can fight the infection there and defeat it, it may exhibit itself only as mild throat irritation, dry cough, or mild fever. Quite often, people who are infected do not even show symptoms; they are asymptomatic. But both those who have mild symptoms or are asymptomatic can infect others.

In most people, COVID-19 is not a serious disease. But in a small proportion of cases, the infection travels to the lungs – the lower respiratory tract – triggering pneumonia. The lungs in such patients show a ground glass effect visible in CT scans. For older people, it can also be accompanied by secondary bacterial infections.

In some cases, COVID-19 becomes particularly dangerous when it causes the immune system to overreact and go berserk. This heightened immune response not only attacks the infected cells but also the healthy cells, creating what is called a cytokine storm and damaging the lungs even further. It is the cytokine storm triggered by the flu of 1918-20 that caused its high mortality. Further, as the SARS-CoV-2 spike protein can bind to other organs in the body by attaching itself to the ACE-2 surface receptor, it also attacks other vital organs and can contribute to multiple organ failures.

What is the possibility of the creation of a vaccine or medicines to stem the pandemic?

Vaccination.

Vaccination became the major route to control infectious diseases caused by viruses. While we did use vaccines against bacterial diseases like the plague, and still use them against other diseases such as typhoid, with the discovery of broad-spectrum antibiotic drugs like sulfa drugs, other antibiotic drugs like penicillin, bacterial infections have become easier to control.

Viral infections are fought largely by the body’s disease-fighting mechanisms. Our antibodies and T cells fight any external invasion, whether by a bacteria or virus. Vaccines trick the body into creating antibodies in our system to fight against infections of specific viruses. The body’s immune system remembers the invaders introduced by the vaccine and knows how to fight the actual infection when it presents itself. For viral diseases, real herd immunity comes from vaccination, which protects a significant part of the population and thereby breaks the transmission chain.

Research institutions and companies are taking different approaches to vaccines. One set of approaches is to use existing technologies – that is, live, inactive, or parts of the viruses to trigger the creation of antibodies. These vaccines are well-known. The other approach is to use the advances in genetic engineering to create new types of vaccines. Both sets of vaccines are entering clinical trials. Most candidate vaccines fail during the clinical trial phase of vaccine development; they may not develop antibodies, the effect may be too small, or they may even trigger negative responses such as an even more serious infections than would have taken place without the vaccine. Vaccine development can take a minimum of 12 to 18 months.

Vaccines are often developed with full patent protection to make profits for private pharmaceutical companies, even though large amounts of public money are invested for their development. Philanthropic capital – which has floated bodies such as GAVI (The Vaccine Alliance) – claims that it supports public good, but has refused to accept that vaccines should be available without any patent protection. China, on the other hand, has said that it will break the chains of patent protection and offer a vaccine as a public good.

Once a drug works, or a vaccine is developed, duplicating it ­is within the powers of any scientifically developed country. The ‘protection’ against such developments is in international treaties and geopolitics (such as in the World Trade Organisation’s Trade-Related Intellectual Property Rights or TRIPS).

Medicines.

Existing drugs are being repurposed to fight the SARS-CoV-2 virus. Human trials will teach us if these repurposed medicines are effective. Several drug trials are in progress, such as a set of drugs being tested through the ‘Solidarity Trials’, the World Health Organisation.

Armed with faith in science and medical knowledge, over two thousand Cuban doctors in the Henry Reeve International Contingent of Doctors Specialized in Disasters and Serious Epidemics have traveled across the world to fight the pandemic on the frontlines. The Contingent, formed in 2005, is named after a US soldier who fought in the Cuban Army of Liberation between 1868 and 1878. His internationalist commitment inspires the Cuban medical personnel. The suffocating air of jingoism and racism is not for them; their internationalism and their commitment to science is what confirms our faith in humanity. CODEPINK has called for the Cuban medical workers to receive the Nobel Prize for Peace. We hope that this will be the case.

Source: Indian Cultural Forum, May 29, 2020.
Under Creative Commons Licence.

WHO releases “interim guidance” for stakeholders for the “ethical and appropriate use of digital proximity tracking technologies for COVID-19”

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From SAT News Desk, Melbourne

The World Health Organisation (WHO) has released an ‘Interim guidance’ (28 May 2020), ‘Ethical considerations to guide the use of digital proximity tracking technologies for COVID-19 contact tracing’ dealing with tracking technologies used in tracing Apps to identify COVID-19 infected patients in many countries including Australia (COVIDSafe) and India (Aarogya Setu). Like many others in the world, the WHO feels, “… these technologies raise ethical and privacy concerns.” This document is exhaustive and deals with issues of technology, human rights, commercial usage of data, effectiveness, proximity, and the need for the legislation among others.
We reproduce below the whole ‘interim guidance’ as it is under the Creative Commons Licence. CLICK on the following link and access/download the original WHO document:

https://www.who.int/publications-detail/WHO-2019-nCoV-Ethics_Contact_tracing_apps-2020.1

FIFA-EC-WHO #SafeHome campaign to support those risking domestic violence

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Photo: WHO Video

By SAT News Desk/WHO

MELBOURNE, 26 MAY 2020: The COVID-19 global crisis has resulted in a big loss of life and the disruption of the economic and social fabric of society. One consequence has been the spike in domestic violence. To plug this and help victims the FIFA, WHO, and the European Commission have joined forces, to launch the #SafeHome campaign to support women and children at risk of domestic violence. The campaign is a joint response from the three institutions to the recent spikes in reports of domestic violence as stay-at-home measures to prevent the spread of COVID-19 have put women and children experiencing abuse at greater risk.

Almost one in three women worldwide experience physical and/or sexual violence by an intimate partner or sexual violence by someone else in their lifetime. In a majority of cases, that violence is committed by a partner in their home – indeed, up to 38% of all murders of women are committed by an intimate partner. It is also estimated that one billion children aged between two and seventeen years (or half the world’s children) have experienced physical, sexual, or emotional violence or neglect in the past year.

There are many reasons why people perpetrate domestic violence, including gender inequality and social norms that condone violence, childhood experiences of abuse or exposure to violence and coercive control growing up. Harmful use of alcohol can also trigger violence. Stressful situations, such as those being experienced during the COVID-19 pandemic and economic instability, exacerbate the risk. Moreover, the current distancing measures in place in many countries make it harder for women and children to reach out to family, friends and health workers who could otherwise provide support and protection.

“Just as physical, sexual or psychological violence has no place in football, it has no place in the home,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “We are so pleased that our partners today are joining us to draw attention to this critical issue. As people are isolated at home because of COVID-19, the risks of domestic violence have tragically been exacerbated.”.

“Together with the World Health Organization and the European Commission, we are asking the football community to raise awareness of this intolerable situation that threatens particularly women and children in their own home, a place where they should feel happy, safe and secure,” said FIFA President Gianni Infantino. “We cannot stay silent on this issue that negatively affects so many people. Violence has no place in homes, just as it has no place in sports. Football has the power to relay important social messages, and through the #SafeHome campaign, we want to ensure that those people experiencing violence have access to the necessary support services they need.”

“Violence has no place in our societies,” said Mariya Gabriel, Commissioner for Innovation, Research, Culture, Education, and Youth. “Women’s rights are human rights and should be protected. Often abused women and children are afraid to talk because of fear or shame. This ‘window’ to speak up and seek help is, during confinement, even more, restricted. As a matter of fact, in some countries, we have seen an increase in reports of domestic violence since the outbreak of COVID-19. It is our responsibility as a society, as institutions to speak up for these women. To give them trust and support them. This is the purpose of this joint campaign which I am honored to be part of.”

“We call upon our member associations to actively publish details of national or local helplines and support services that can help victims and anyone feeling threatened by violence in their locality,” added the FIFA President. “We also call upon our members to review their own safeguarding measures using the FIFA Guardians toolkit to ensure that football is fun and safe for everyone in our game, especially the youngest members of the football family.”

The five-part video awareness campaign features 15 past and present footballers – Álvaro Arbeloa, Rosana Augusto, Vítor Baía, Khalilou Fadiga, Matthias Ginter, David James, Annike Krahn, Marco Materazzi, Milagros Menéndez, Noemi Pascotto, Graham Potter, Mikaël Silvestre, Kelly Smith, Óliver Torres and Clementine Touré – who have stressed their support to address this critical issue. The campaign is being published on various FIFA digital channels, with #SafeHome also being supported with multimedia toolkits for the 211 FIFA member associations and for various media agencies to help facilitate additional localization and to further amplify the message worldwide.

Video 1: Survivor advice 1

Video 2: Survivor advice 2

Video 3: Survivor support

Video 4: Perpetrator advice

Video 5: Government advice

WHO, the United Nations’ specialized health agency, and FIFA, football’s world governing body, collaborate closely to promote healthy lifestyles, which includes being free of violence, through football globally. The two organizations jointly launched the “Pass the message to kick out coronavirus” campaign in March 2020 to share advice on effective measures to protect people from COVID-19. This was followed by the #BeActive campaign in April 2020 to encourage people to stay healthy at home during the pandemic.

Smithsonian Science Education Center – WHO launch new COVID-19 Guide for Youth

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By SAT News Desk

MELBOURNE, 21 MAY 2020: It is essential for young people to understand the science and social science behind COVID-19 to protect and keep themselves and others safe during the pandemic. To address this the Smithsonian Science Education Center, in collaboration with the World Health Organization (WHO) and the InterAcademy Partnership (IAP)—a partnership of 140 national academies of science, engineering, and medicine—has developed “COVID-19!

How can I protect myself and others?,” a new rapid-response guide for youth ages 8–17. The guide, which is based on the UN Sustainable Development Goals, aims to help young people understand the science and social science of COVID-19 as well as help them take action to keep themselves, their families and communities safe.

Through a set of seven cohesive student-led tasks, participants engage in the activities to answer questions previously defined by their peers. The questions explore the impact of COVID-19 on the world, how to practice hand and respiratory hygiene and physical distancing, and how to research more information about COVID-19. The final task teaches youth how they can take action on the new scientific knowledge they learn to improve their health and the health of others. Each task is designed to be completed at home.

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The guide includes updated research, activities, quotes from scientists and frontline public health officials, and physical and emotional safety tips on COVID-19. It also integrates inquiry-based science education with social and emotional learning and civic engagement.

“We are immensely grateful to WHO, the IAP, our colleagues at the Smithsonian and other senior project advisors and translators for their perspectives and technical support in ensuring the science is accurate,” said Carol O’Donnell, director of the Smithsonian Science Education Center. “We are also grateful to the Gordon and Betty Moore Foundation for their support during the development of this module. This work represents the power of collaboration and working closely with others across the globe, even during a time of physical distancing.”

“Through this project, the Smithsonian Science Education Center makes science exciting and approachable for children and youth all over the world and encourages them to learn by doing” said Dr. Soumya Swaminathan, chief scientist at WHO. “With all the myths and misconceptions out there, it is important for children and youth to understand the nature of this pandemic and what can be done to prevent future pandemics from happening,”

“It is so important for children—wherever they are in the world—to develop their scientific understanding and rational thinking,” said Professor Volker ter Meulen, president of IAP. “Only by being able to make rational decisions based on the best science and evidence can any of us adjust our behavior to keep ourselves and our families safe from infections such as COVID-19.”

The Smithsonian Science Education Center will disseminate the information to youth worldwide in collaboration with WHO, IAP, educators, and museum and research center networks. The guide is free, will be available to youth in more than 15 languages, particularly African and Asian languages, and can be found at https://ssec.si.edu/covid-19